Provider Demographics
NPI:1083777130
Name:DE LA PAZ, MICHAEL LAWENKO (PT PHYSICAL THERAPIS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LAWENKO
Last Name:DE LA PAZ
Suffix:
Gender:M
Credentials:PT PHYSICAL THERAPIS
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:115 N SAN MARINO AVE
Mailing Address - Street 2:APT D
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775
Mailing Address - Country:US
Mailing Address - Phone:626-281-8602
Mailing Address - Fax:
Practice Address - Street 1:438 W LAS TUNAS AVE
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776
Practice Address - Country:US
Practice Address - Phone:626-570-6587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist